Combining rightshoring and design thinking to reduce costs and improve value-based care

The solution

Sagility was with the client at the table during the early stages of the development of this business excellence model. With four decades of extensive expertise and experience, we were able to bring to this program development our healthcare knowledge expertise across commercial and government healthcare segments, as well as our overall extensive experience working across geographies to build and establish standardized processes, uniformity of tools and methodologies, and continual improvement.

Sagility and our partner worked closely to co-create a business excellence framework centered on the mission of globalized service excellence, with a Unified Customer Engagement® across channels and along the lifecycle. Employing Sagility’s design thinking innovation and consultative approach, we provided the cross-training and skillset focus to drive for higher SLAs and a premier, precedent-setting service excellence. We designed a complete revamp of all operational processes—working with the client to analyze those service elements that critically affect service delivery. What were the strengths, weaknesses, and opportunities in hiring? What is the ideal profile for agent fit? What training improvements were needed to optimize CSAT, member retention, and—at the core of it all, agent performance and engagement? Sagility worked closely with our client, sharing our own business excellence expertise, to assess voice of the customer feedback, ask the right questions, and then provide the solution consulting for a program designed to specifically meet excellence objectives. The final program mission was to better advocate for members’ optimal health by helping them get the most from their benefits, building trust, and always providing a clear path to care.

When this project launched, the Pilot Voice Services Team was evenly divided between two locations in Manila, Philippines and comprises one Operations Manager, two Shift Managers, two Team Leads, two Training Managers, two Line Trainers and 20 CSRs. At the heart of our business excellence model are key solution features, to support an agent that advocates striving to help members optimize their benefits.

A more empowered agent with member engagement mindset that incorporates the common purpose in all of their phone calls. This includes better engagement with service improvements such as:

• Answering the unasked questions that members or provider offices don’t know to ask
• Educating members on the special health programs that they have available
• Building trust with active listening and accurate info provision
• Providing clear and complete explanations on service asks like procedure steps or assistance finding a doctor
• Offering a lifeline that can be called for the right answer, faster—for example, cost parameters or pharmacy representative-specific help. This information is just a phone call away for agents providing service within this business excellence framework
• When needed, educating providers on the steps they need to take to obtain a precertification for the member’s procedure

Ultimately, with these premier service excellence features, Sagility has provided customer-centric focused excellence that is transforming this client’s member engagement, for a more B2C market leading approach. Client ROI for this program has been immediate. The Business Excellence Model Team’s performance has been outstanding from day one, with improvements in AHT, FCR, and CSAT. For example, year-to-date quality reached 99.45% in only five months, while Sagility drove CSAT to 96.9%, for a 50% reduction in dissatisfiers. Another critical outcome that showcases the source of the positive outcomes for the client? At the five-month mark, agent attrition is 0%.

The client, impressed with our grasp of operational efficiencies, sought our help in another area of their business: a proof of concept on Medicare Part D. They already trusted our claims management expertise, and they understood firsthand that, with our deep domain knowledge of both commercial and Medicare market segments, we were well versed in the stringent regulations and compliance of government healthcare programs. Ultimately, this client was looking for a more effective process and better use of costly clinical resources as part of their drug labelling and authorization process. Their existing process was burdened with turnaround time (TAT) issues, inconsistent accuracy, and a cumbersome need to source, recruit, and train highly paid clinical resources for a short period during open enrollment each year.

For our PoC, Sagility leveraged our Bangalore and El Paso locations to employ trained (but unlicensed) resources with pharmacy claims knowledge to follow a 24×7 process that decouples initial call triage and fax labelling from the actual clinical authorization process. With our proprietary workflow solution, Sagility handles each provider/member interaction with the appropriate level of trained resource (clinical and non-clinical), thereby making the most cost-effective use of both high-cost clinical and lower-cost non-clinical resources. Sagility has also re-engineered the working hours and locations on a “follow-the-sun” model to ensure adherence to strict regulatory requirements for TAT on all transactions.

In addition to TAT and cost improvements, Sagility’s decoupled approach solves for the critical—and often overlooked—issue of incorrect drug form labeling, which can result in non-compliance with CMS audit, lowered CAHPS rating, and possible federal sanctions.

Sagility’s key role in the Med D drug review and authorization process has included:

• Offshore—Validation of the drugs listed in provider faxes and ensuring appropriate drug labeling before transferring to clinical personnel (licensed pharmacy technicians) to approve or deny claims
• Onshore—Triaging member calls and handling or routing calls to the appropriate resource based on member need, including referral to clinical resources for authorizations/denials needing immediate clinical decisions

With a flexible, decoupled process that provides for optimal process timing and effective resource allocation/utilization, the ROI was immediate for our client and included better turnaround time (25% improvement), significantly improved accuracy and consistency, substantial cost savings (greater than $1 million per year), and reduced need for expensive clinical personnel. Sagility was also able to drive a 60% improvement in call average handle time (AHT) from initial estimates and trigger a mutually successful gain-sharing program. This program was designed to incent the client and Sagility teams to work hand-in glove toward improving the Med D drug approval/denial process.